Location, time units now required, intermediary instructs.
Hospices that are used to pretty simple Medi-care billing are having to adjust.
Medicare is now requiring more line-item details on hospice claims, regional home health intermediary Palmetto GBA explains on its Web site.
"Over the past decade, Medicare has instituted progressively more complex payment methods," the RHHI notes. But hospices have been left out of the requirements--until now. "The limit of claims data has restricted Medicare's ability to ensure payment accuracy and to prudently analyze services provided in this benefit," Palmetto says.
Old way: Before, hospices had to use only "a small number of service lines to report the days and/or hours of the four levels of care," the intermediary says. "HCPCS codes were only required when reporting physician billing for procedures provided by hospice employed/contracted physicians."
New way: Now hospice claims must include HCPCS codes that indicate the location of services rendered, Palmetto instructs. Hospices can use the following codes: Q5001--Beneficiary's home/residence
Q5002--Assisted Living Facility (ALF)
Q5003--Nursing Long Term Care Facility (LTC) or Non-Skilled Nursing Facility (NF)
Q5004--Skilled Nursing Facility (SNF)
Q5005--Inpatient Hospital
Q5006--Inpatient Hospice Facility
Q5007--Long Term Care Hospital (LTCH)
Q5008--Inpatient Psychiatric Facility
Q5009--Place not Otherwise Specified (NOS). Units for most levels of care will stay the same. But hospices can no longer round continuous care to the hour and must report 15-minute units, Palmetto warns.
Example: Bill eight hours as 32 units. Enter nine hours, 45 minutes as 39 units, Palmetto advises.
Remember: Continuous care claims must reflect a minimum of eight hours of continuous care, Palmetto reminds providers. "Only direct patient care during a period of crisis is billable," it adds.
Resource: The Centers for Medicare & Medicaid Services issued a July 28, 2006 transmittal about the changes at
www.cms.hhs.gov/transmittals/downloads/R1011CP.pdf.
Palmetto targeted continuous care for a probe last spring. (For tips on defending continuous care hours against scrutiny, see Eli's HCW, Vol. XV, No. 15) • Three home health agencies successfully have settled their appeals over physical therapist compensation, reports their attorney, Joel Hamme with Powers Pyles Sutter & Verville in Washington, DC. The HHS Administrator had overturned Provider Reimbursement Review Board decisions for Broomfield, CO-based Colorado Home Care Inc., Kingston, PA-based Erwine's Home Health Care Inc. and Rockville, MD-based Potomac Home Health Care.
The three agencies appealed the reversals in federal court. The government paid 100 percent of the underlying claim and 100 percent of applicable interest to two providers and 100 percent of the underlying claim plus its attorney's fees to the last provider, Hamme reports.
The cases arose when the intermediary applied outside contractor salary limits to PTs employed directly by the agencies but paid per visit. • Providers served by RHHIs United Government Services and Associated Hospital Service of Maine are seeing more changes resulting from the intermediaries' merger into parent company National [...]
